Eat Well, Be Well: Managing Emotional Eating Using DBT Tools

What is the connection between stress and eating?

According to the American Diabetes Association (ADA), emotions can influence when, what, and how much we eat. If you have ever found yourself eating even when you are not hungry, emotions may have been the culprit. Some people eat to cope with boredom; others eat to cope with stress. Research shows that stress causes chemicals called glucocorticoids and insulin to be secreted, which drive motivation for food. Some people try to seek relief from uncomfortable feelings of stress through comfort eating. Over time, comfort eating can become a habit.

How can I use mindfulness and other DBT skills to stop emotional eating?

Researchers emphasize the importance of taking a mindful approach to notice the urge to comfort ourselves with food when we are experiencing tough feelings. Mindfulness can help us recognize when we are actually hungry or when we are eating to avoid negative feelings. It can also help us make more conscious choices about what we eat.

Mindfulness is a core component of Dialectical Behavior Therapy (DBT), a cognitive-behavioral treatment initially created for people with borderline personality disorder and chronic suicidality and now acknowledged as the gold standard for this population. Research has also shown that DBT is effective in treating substance dependence, depression, post-traumatic stress disorder, and eating problems. The word "dialectic" means an integration of opposites. The main dialectic in DBT is between change and acceptance. DBT has four modules, including two groups of acceptance-based skills (mindfulness and distress tolerance) and two groups of change-based skills (emotion regulation and interpersonal effectiveness).

In the book The DBT Solution for Emotional Eating, the authors Dr. Debra Safer, Sarah Adler, and Philip Masson explain that mindful eating is "a way to focus your attention on what you are eating and allows you to listen to your body and better tell when you are hungry or full." Mindfulness and emotional eating are fundamentally incompatible, the authors explain. Mindfulness entails increased awareness, whereas emotional eating, or stress eating, is mindless. Mindful eating means slowing down, bringing full awareness and attention to each bite, taste, and chew while keeping in mind your values and long-term best interests.

Mindful eating involves three skills, according to the authors:

1. Observing
2. A nonjudgmental approach
3. Focusing on one thing in the moment

The authors note that it can be helpful to practice mindful eating when you are not anxious or stressed, so you're more prepared to prevent emotional eating when you are feeling vulnerable. Since research shows that it can take at least 20 minutes for a feeling of fullness to occur, the authors recommend practicing mindfulness to permit your brain enough time to let your stomach know that your physical hunger has decreased. 

The ADA provides a helpful list of words to help identify emotions that trigger a desire for food, which is a great tool for bringing more mindful awareness to the urge to eat.

• Afraid
• Alone
• Angry
• Anxious
• Blue
• Bored
• Content
• Depressed
• Disappointed
• Fearful
• Frustrated
• Good
• Grief
• Guilty
• Happy
• Hate
• Insecure
• Jealous
• Lonely
• Lust
• Nervous
• Regret
• Sad
• Scared
• Self-pity
• Shame
• Sleepy
• Stress
• Tired
• Worried

If you have eaten recently and find yourself longing for food again, the ADA recommends doing a fast feelings check-in. Are you craving food to fill an emotional need or because you are actually hungry?

• Check in with your physical hunger using the Hunger-Satiety Rating Scale.

• Track what food you ate, how hungry you are when you eat, and how you feel at the time. You will get a better picture of which negative feelings prompt your urge to eat when you are not physically hungry. 
• Remember which situations and feelings trigger your urge to eat.
• Write a list of other things to do to cope with your negative feelings. Foor example, do some movement like walking or stretching, text or phone phone a friend, or have a drink of water.
• If you are really struggling to resist the urge to eat based on a negative feeling, recruit your friends or family to support you in losing weight. Your health care team, therapist, or a support group can also help you. 

What is urge surfing, and how can it help me curb my emotional eating?

The authors of the The DBT Solution for Emotional Eating introduce the concept of "urge surfing" as a way to wait for the urge to eat to go down rather than succumbing to it. This technique draws on the mindful eating skills described above. In urge surfing, patients are asked to notice their urge to eat as it goes up, goes down, and eventually goes away.

If emotional eating feels habitual to you, it can be hard to believe that an urge is actually a choice you actively make or do not make. With emotional eating, the connection between experiencing an urge and acting on it has been reinforced, the authors note. With urge-surfing, you are retraining your brain to learn that you are capable of experiencing an urge without acting on it. Every time you practice urge-surfing, you are reinforcing this new learning .

To practice urge surfing, the authors explain, picture your urge to engage in emotional eating as if it were a wave on the ocean, and yourself as riding the crest of the wave with your feet on an imaginary surfboard. Use your mindfulness skills of observing, focusing on one thing in the moment, and taking a nonjudgmental approach. When you first pick up on the urge, it might feel overwhelming, and it might get bigger as you ride it. Do not try to get rid of the urge -- just observe it as it rises and falls. Urges do not go on forever; they typically last around 20 minutes and go away on their own if you do not give into them. Keep riding yours out until you arrive at the shore.

What is radical acceptance, and how can it help with emotional eating?

In the DBT Solution for Emotional Eating, the authors explain that radically accepting your emotions means embracing your feelings in a "deep and fundamental way" without necessarily approving of them. Instead of battling your feelings, you accept them, and turn your focus to figuring out what you can do to change the trigger that might be fueling the emotion -- while also accepting the things you are unable to change.

When you engage in emotional eating to try to avoid negative, painful emotions, you end up suffering more. Escaping emotional pain through eating keeps you mired in an effort to fight reality. Being mired in reality-fighting and refusing to accept emotional pain fuels suffering. Radical acceptance is a helpful skill to get you unstuck, the authors note, to tolerate feelings that are hard to experience and provide you with choices besides emotional eating. 

The authors clarify that radical acceptance does not mean getting rid of emotional pain, but rather shifting ongoing suffering into a more manageable experience of emotional pain in the moment. Radical acceptance is about accepting that negative, difficult feelings are a component of the universal human experience and are unavoidable. Radical acceptance is not easy; it's a skill that requires practice over time.

The authors suggest practicing radical acceptance with the following exercise:

1. Think about a situation that you are having trouble accepting. Notice the upsetting feeling that arises when you think about the details. 
2. When you are ready, practice accepting your upsetting feeling. Use your mindfulness skills (observing and being nonjudgmental). Observe the urge to get rid of the negative feeling and validate it.
3. Remind yourself that radical acceptance permits you to accept your feeling, instead of turning to eating to try to avoid it. Remind yourself of times that you would have liked to have accepted your feelings instead of relying on eating, which may have made suffering worse. 
4. Breathe in and out for 10 breaths, bringing new understanding to the usefulness of radically accepting your feelings in the present situation.

Half-smiling is an exercise that you can use to promote radical acceptance. By shifting your external expression, you can change your internal acceptance. The authors of The DBT Solution for Emotional Eating explain that half-smiling is not about denying feelings, but about making a choice to change your feelings by shifting the feedback that your brain receives from your facial muscles.

The DBT Skills Training Manual by Marsha Linehan recommends practicing half-smiling with these steps:

1. Relax your face from the top of your head down to your chin and jaw. Let go of each facial muscle (forehead, eyes, and brows; cheeks, mouth, and tongue; teeth slightly apart). If you have difficulty, try tensing your facial muscles and then letting go. 

2. Let both corners of your lips go slightly up, just so you can feel them. It is not necessary for others to see it. A half-smile is slightly upturned lips with a relaxed face.

3. Try to adopt a serene facial expression. Remember, your face communicates to your brain; your body connects to your mind.

What are distress tolerance skills, and how can I use them to stop emotional eating?

When you feel that your emotions are just too overwhelming or painful and the skills described above are not enough, turn to distress tolerance skills, the authors of The DBT Solution for Emotional Eating recommend. Remember that many people eat to avoid or escape their stress. 

While distress tolerance skills do not help you change a distressing situation, they can help you get through extremely painful moments by providing you some relief and giving you a new perspective without turning to emotional eating. If you have been engaging in emotional eating for many years, these skills will take time and practice to learn, but they are a much more effective, healthy way of managing overwhelmingly painful feelings than impulsively turning to food.

Distraction skills are the first distress tolerance skill. You can practice distraction in several ways:

1. Activities: Going for a walk or doing other exercise, cooking, cleaning, calling/texting a friend
2. Contributing: Helping a family or friend, volunteering, surprising someone
3. Comparison: Comparing yourself to other people coping less well than you
4. Opposite emotions: Watching funny YouTube videos, movies, or TV shows; listening to emotionally-charged music; reading a scary or funny book
5. Pushing away: Putting up a mental barrier between yourself and the stressful situation and feelings by building a mental wall or putting the pain in a box or on a shelf
6. Thoughts and sensations: Holding ice, snapping a rubber band on your wrist, listening to loud music, taking a hot shower, going for a cold swim.

The second type of distress tolerance skill is self-soothing skills. Having self-compassion and nurturing yourself through your five senses is a much more effective way to cope with overwhelming feelings than eating and is far better for your body and self-esteem in the long run, note the authors of The DBT Solution for Emotional Eating. Rather than turning to eating, you can nurture and comfort yourself in the face of overwhelming negative feelings through:

1. Vision: Walking around a visually pleasing neighborhood; walking in nature; buying yourself flowers; lighting a candle; looking at a beautifully illustrated book; watching a travel show
2. Hearing: Listening to music or nature sounds
3. Smell: Putting on scented lotion or perfume; lighting incense or a candle; baking something
4. Taste: Drinking something soothing, like decaf coffee or hot tea
5. Touch: Petting your dog or cat; snuggling in your bed or under a blanket; putting on silk pajamas; taking a bath

The third variety of distress tolerance skills is weighing the pros and cons. This skill involves contemplating the costs and benefits of managing overwhelming stress in effective, skillful ways (using the skills described above), rather than turning to emotional eating. The authors of The DBT Solution for Emotional Eating emphasize that weighing the pros and cons of emotional eating in the moment gives you the chance to make an informed decision about using a healthy, effective coping skill or an unhealthy, ineffective one -- reinforcing that emotional eating is a choice rather than an inevitable, automatic behavior.

Try using a table (see example below), mentally or through writing, to list out the pros and cons of practicing healthy coping skills like the ones in this article the next time you experience the urge to engage in emotional eating. You will likely find that the cons of not tolerating your distress are many, and the pros of tolerating your distress using DBT skills win out.

A final word on DBT and mindfulness skills for emotional eating

If you are struggling with emotional eating, practicing mindfulness and DBT skills regularly can help you better handle your urges and gain control of your emotional eating. These skills are a healthier, more effective alternative to coping with stress and intense emotions than eating impulsively. The idea is to continue to practice the DBT skills, so they become more automatic than relying on food to manage stress and other difficult emotions. If you have already tried implementing many of these skills and you are still struggling to manage your emotional eating, talk to your primary care doctor. Emotional eating is a learned behavior, and your doctor can help connect you with ways to unlearn it.